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目的 :探讨中老年人脉压 (PP)水平对急性心肌梗死 (AMI)发病的预测价值。方法 :于 1991年 8月对山东省中老年人群进行心血管病危险因素的基线调查 ,对AMI事件的发病进行随访登记。到 1999年底 ,110 0 8例中老年人共发生AMI 117例 ,应用Cox回归分析PP对AMI的预测价值。结果 :AMI患者的PP均值[5 8.4 2mmHg(1mmHg =0 .133kPa) ]明显高于非AMI者的PP均值 [(5 0 .0 4mmHg) ,(P <0 .0 1) ]。校正其他危险因素后 ,老年人PP每增加 10mmHg ,AMI危险增加 2 9.8% ;在每一舒张压水平 ,PP每增加 10mmHg ,AMI危险增加 2 5 .7% ,但不独立于收缩压。中年人PP不是AMI的预测指标 ,而平均动脉压和舒张压则是。老年人PP≥ 5 0mmHg者患AMI危险为PP 4 0～ 4 9mmHg者的3.2～ 3.3倍 ,校正舒张压后依然如此 ;PP <4 0mmHg者AMI危险有增高的趋势 ,但差异无统计学意义。结论 :①PP为老年人AMI新的预测因子 ,但不独立于收缩压。中年人AMI危险主要与平均动脉压和舒张压相关。②老年人PP≥ 5 0mmHg应作为AMI危险的界值 ,且PP 4 0～ 4 9mmHg时AMI的风险最小。
Objective: To investigate the predictive value of pulse pressure (PP) in the elderly on the incidence of acute myocardial infarction (AMI). METHODS: A baseline survey of risk factors for cardiovascular disease in middle-aged and elderly people in Shandong Province was conducted in August 1991 to follow up the incidence of AMI. By the end of 1999, there were 117 AMI cases in 110 0 8 middle-aged and elderly people. Cox regression was used to analyze the predictive value of PP for AMI. Results: The mean PP of 5 8.42mmHg (1mmHg = 0.133kPa) in patients with AMI was significantly higher than that of non-AMI patients (5.04mmHg, P <0.01). After adjusting for other risk factors, the risk of AMI increased by 9.8% for every 10 mmHg increase in elderly people. At each diastolic blood pressure level, the risk of AMI increased by 25.7%, but not independently of systolic blood pressure, for every 10 mmHg increase in PP. Middle-aged PP is not a predictor of AMI, while mean arterial pressure and diastolic blood pressure are. The elderly with PP ≥ 50 mmHg risk of AMI PP 4 0 ~ 4 9mmHg 3.2 ~ 3.3 times those after correction of diastolic blood pressure is still the case; PP <40mmHg AMI risk increased, but the difference was not statistically significant. Conclusion: ① PP is a new predictor of AMI in the elderly, but not independent of systolic blood pressure. Middle-aged AMI risk is mainly associated with mean arterial pressure and diastolic blood pressure. ② The elderly PP ≥ 50 mmHg should be used as the cut-off point of AMI risk, and the risk of AMI is the smallest when PP 4 0 ~ 49 mmHg.